i tried to cover nursing management part in detailed . your comment and likes are helpful for us to future betterment so please do that.

1. By.
MR. ABHIJIT BHOYAR
M SC. NURSING
MENINGITIS

2. INTRODUCTION
 Meningitis is an inflammation of the meninges.
 The meninges are the three membranes that cover the brain
and spinal cord.
 Meningitis can occur when fluid surrounding the meninges
becomes infected.
 The most common causes of meningitis are viral and
bacterial infection

3. DEFINITION

4. TYPES
Meningitis can be classified as:
1) Pyogenic meningitis or bacterial
meningitis
2) Tuberculor meningitis
3) Aseptic meningitis (caused by virus,
fungus, protozoa.)

5. CAUSES
 VIral infections
 Bacterial infections
 Fungal
 Parasitic infections.
 Because bacterial infections can be life-threatening,
identifying the cause is essential.

6. RISK FACTORS
Risk factors for meningitis include:
 SKIPPING VACCINATIONS. Risk rises for anyone
who hasn't completed the recommended childhood or
adult vaccination schedule.
 AGE. Most cases of viral meningitis occur in children
younger than age 5. Bacterial meningitis is common in
those under age 20.

7.  Living in a community setting. College students living in dormitories,
personnel on military bases, and children in boarding schools and child
care facilities are at greater risk of meningococcal meningitis. This is
probably because the bacterium is spread through the respiratory route,
and spreads quickly through large groups.
 Pregnancy. Pregnancy increases the risk of listeriosis — an infection
caused by listeria bacteria, which may also cause meningitis. Listeriosis
increases the risk of miscarriage, stillbirth and premature delivery.

8.  Compromised immune system. AIDS, alcoholism,
diabetes, use of immunosuppressant drugs and other
factors that affect your immune system also make you
more susceptible to meningitis. Having your spleen
removed also increases your risk, and anyone without a
spleen should get vaccinated to minimize that risk.

9. PYOGENIC MENINGITIS
OR
BACTERIAL MENINGITIS
 Bacterial meningitis is an inflammation of the meninges
that follows the invasion of the spinal fluid by a bacterial
agent.
 Most cases are seen in children younger than age 5.

10. NASOPHARYNGEAL COLONIZATION
LOCAL INVASION
BACTEREMIA
ENDOTHELIAL CELL INJURY
MENINGEAL INVASION
SUPRAARACHNOID SPACE INFLAMMATION
INCREASED CSF FLOW RESISTANCE
HYDROCEPHALOUS
INTERSTITIAL EDEMA
INCREASED INTRACRANIAL PRESSURE
DECREASED CEREBRAL BLOOD FLOW
INCREASED BBB
PERMIABILITY
CYTOTOXIC
EDEMA
CEREBRAL
VASCULITIS
VASOGENIC EDEMA
CEREBRAL
INFARCTION

11. CLINICAL MANIFESTATION
 Infants younger than age 2
months usually display
 Irritability,
 Lethargy,
 Vomiting,
 Lack of appetite,
 Seizures,
 High-pitched cry,
 Fever or hypothermia.
Signs and symptoms are variable, depending on the patient's age, the
etiologic agent, and the duration of the illness when diagnosed.
Onset may be insidious or fulminant.

13. Infants up to age 2 manifest symptoms similar to
those of the young infant and may have
 Altered sleep patterns,
 Fever,
 Tenseness of the
fontanelle,
 Nuchal rigidity,
 Positive kernig's sign’s
 Brudzinski's signs

15. Children older than age 2 initially
have
 Vomiting,
 Headache,
 Mental confusion,
 Lethargy, and
 Photophobia.
 Later symptoms include
nuchal rigidity within 12
to 24 hours after onset,
 Positive kernig's or
 brudzinski's sign,
 Seizures,
 Progressive decline in
responsiveness

16.  Petechiae or purpura may develop.
– Characteristic skin lesions are most commonly observed
in cases of meningococcal or Pseudomonas infection.
– Hemorrhagic rashes may occur in any child with
overwhelming bacterial sepsis because of disseminated
intravascular coagulation (DIC).
 Septic arthritis suggests either meningococcal or H.
influenzae infection

17. DIAGNOSTIC INVESTIGATION
 Diagnosis is usually established by
performance of a lumbar puncture and
examination of the CSF.
– Cloudy or turbid appearance.
– Elevated CSF pressure.
– High cell count with mostly polymorphonuclear cells.
– Low glucose level.
– Elevated protein level (also may be normal).
– Positive Gram stain and cultures (identifies the
causative organism).

18. Additional laboratory studies
include the following:
– Complete blood count (CBC) total white blood
cell count usually increased, with a
preponderance of young neutrophils in the
differential blood.
– Blood, urine, and nasopharyngeal cultures to
look for source of infection.
– Platelet count, serum electrolytes, glucose,
blood urea nitrogen and creatinine, and
urinalysis usually done to monitor critically ill
patient.

19. MANAGEMENT
 I.V. administration of the appropriate antimicrobial
agents to promote rapid destruction of the bacteria and
to suppress the emergence of resistant strains.
 The first dose of antibiotics should be administered as
soon as possible (cultures should be taken before an
antibiotic is given).

20.  Recognition and treatment of hyponatremia caused by
syndrome of inappropriate antidiuretic hormone
(SIADH).
 Supportive management of the comatose child or the
child with seizures.
 Appropriate prophylactic treatment provided for
contacts when indicated

21. COMPLICATIONS
 ACUTE COMPLICATION
 seizures,
 Cerebral edema
 Increased ICP,
 Shock,
 SIADH.
 LONG-TERM
COMPLICATION
 ”Sensorineural hearing
loss,
 Hydrocephalus,
 Blindness,
 Learning disabilities
 Developmental delays.

22. NURSING ASSESSMENT
 Obtain a history from the parents about recent upper
respiratory or other infection.
 Assess LOC and neurologic status.
– Evaluate for Kernig's sign with the child in the supine position
and knees flexed, flex the leg at the hip so the thigh is brought
to a position perpendicular to the trunk.
– Attempt to extend the knee.
– If meningeal irritation is present, this cannot be done, and
attempts to extend the knee result in pain.

23. – Evaluate for Brudzinski's sign
– flex the patient's neck.
– Spontaneous flexion of the lower extremities
indicates meningeal irritation.
 Monitor breathing pattern and circulatory
status

24. Nursing Diagnoses
 Ineffective Tissue Perfusion: Cerebral related to endotoxin release
into the CSF
 Hyperthermia related to infectious process
 Acute Pain related to neurologic effects from the disease process
 Risk for Infection transmission related to bacterial agents
 Ineffective Tissue Perfusion: Cerebral related to complications of
infectious process
 Anxiety of parents related to severity of illness and hospitalization

25. Maintaining Cerebral Tissue Perfusion
 Administer antimicrobial agents at specified time intervals to obtain
optimal serum levels.
 Maintain patent I.V. line for medication administration;
 observe for signs of infiltration and phlebitis.
 Monitor closely for signs of complications affecting cerebral
perfusion.
– Monitor vital signs, LOC, and neurologic status at frequent intervals.
– Monitor intake and output, weight, and head circumference daily to assess for
hydrocephalus.
– Be especially alert for lethargy or subtle changes in condition, which may
indicate cerebral edema.
 Accurately chart child's behavior and clinical signs
NURSING INTERVENTIONS

26. Relieving Pain and Irritability
 Reduce the general noise level around the child, and prevent
sudden loud noises.
 Organize nursing care to provide for periods of
uninterrupted rest.
 Keep general handling of the child at a minimum. When
necessary, approach the child slowly and gently.
 Maintain subdued lighting as much as possible.
 Speak in a low, well-modulated tone of voice.
 Medicate for pain as ordered, avoiding opioids that cause
CNS and respiratory depression.

27. Preventing Transmission of
Infection
 Use precautions until at least 24 hours after initiation of
appropriate antibiotic therapy.
 Practice careful hand-washing technique.
 Make sure that personnel with colds or other infections
avoid contact with infants with meningitis, and wear a mask
when it is necessary to enter the nursery.
 Teach parents and other visitors proper hand-washing and
gown techniques.
 Maintain sterile technique for procedures when indicated.

28. Avoiding Complications
 Monitor for and report any of the following:
– Decreased respirations, decreased pulse rate, increased systolic
BP, pupillary changes, or decreased responsiveness, which may
indicate increased ICP.
– Decreased urine volume and increased body weight, which may
indicate SIADH.
– Sudden appearance of a skin rash and bleeding from other sites,
which may indicate DIC.
– Persistent or recurring fever, bulging fontanelle, signs of increased
ICP, focal neurologic signs, seizures, or increased head
circumference, which may indicate subdural effusion.
– Hearing disturbances and apparent deafness, indicating cranial
nerve involvement.

29.  Observe for episodes of apnea, and initiate measures to stimulate
respiration.
– Institute respiratory monitoring.
– Stimulate the infant when apnea does occur.
 Pinch feet and provide more vigorous stimulation if necessary.
 When spontaneous respiration does not occur within 15 to 20
seconds, provide bag or mask ventilation.
– Report any periods of apnea.
 Record length of apnea episode and response to stimulation

30. Allaying Parental Anxiety
 Encourage the parents to engage in quiet activities with
their child, such as reading or listening to soft music.
 Provide the parents with an opportunity to express their
concerns and answer questions they may have regarding
the child's progress and care.
 Engage the parents in the supportive care of the child so
they may feel some control over the situation.

31. FAMILY EDUCATION AND HEALTH
MAINTENANCE
 Provide parents with appropriate information if they
and other family members are to receive antibiotic
prophylaxis, usually one dose of rifampin (Rifadin).
 Discuss symptoms for which the parents should
watch as signs of possible latent complications,
especially hydrocephalus

32.  Give specific instructions about medications to be
administered at home.
 Encourage regular health maintenance visits to chart
growth and development and assess for any delays.
 Parents can obtain more information about
meningitis at the Centers for Disease Control

33. PREVENTION
 These steps can help prevent meningitis:
 Wash your hands.
 Practice good hygiene.
 Stay healthy.
 Cover your mouth
 Some forms of bacterial meningitis are
preventable with the vaccinations